Hip Labral Tears: Difference between revisions
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== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
Due to difficulties in identifying specific mechanisms of injury for hip labral tears, generalizing typical signs and symptoms proves to be a rather challenging task. Ninety percent of patients with a hip labral tear have complaints of anterior hip and/or groin pain. <ref name="comp" /><ref name="LS" /> Less common areas of pain include anterior thigh pain, lateral thigh pain, buttock pain, and radiating knee pain. | Due to difficulties in identifying specific mechanisms of injury for hip labral tears, generalizing typical signs and symptoms proves to be a rather challenging task. Ninety percent of patients with a hip labral tear have complaints of anterior hip and/or groin pain. <ref name="comp" /><ref name="LS" /> Less common areas of pain include anterior thigh pain, lateral thigh pain, buttock pain, and radiating knee pain. <ref name="LHJ" /><ref name="comp" /> Pain patterns and additional symptoms reported in studies include insidious onset of pain, pain that worsens with activity, night pain, clicking, catching, or locking of the hip during movement <ref name="LS" /><ref name="comp" />. Functional limitations may include prolonged sitting, walking, climbing stairs, running, and twisting/pivoting <ref name="LS" /><ref name="LHJ" /><ref name="comp" />. | ||
According to a 2008 study by Martin et al, symptoms of groin pain, catching, pinching pain with sitting, FABERs test, flexion-internal rotation, adduction impingement test, and trochanteric tenderness were found to have low sensitivities (.6-.78) and low specificities (.10-.56) in identifying patients with intra-articular pain. <br> | According to a 2008 study by Martin et al, symptoms of groin pain, catching, pinching pain with sitting, FABERs test, flexion-internal rotation, adduction impingement test, and trochanteric tenderness were found to have low sensitivities (.6-.78) and low specificities (.10-.56) in identifying patients with intra-articular pain. <br> | ||
Revision as of 22:26, 16 July 2011
Original Editor - Alisha Lopez
Lead Editors - Chris Slininger, Kristen Tsuei, Jenny Nordin, Thomas F Lawlor, Alisha Lopez
Search Strategy[edit | edit source]
Databases Searched: PTJ, Pubmed, CINAHL, Cockrane
Keywords Searched: hip labral tears, acetabular labrum, acetabular labral tears, Hip labral lesions & examinations
Search Timeline: July 1 2011 -
Definition/Description[edit | edit source]
The hip labrum is a structure made of dense connective tissue and fibrocartilage that outlines the
acetabular socket. This continuous structure composed of Type 1 collagen attaches to the bony rim of the acetabulum. The labrum is wider and thinner in the anterior region of the acetabulum and thicker in the posterior region. [1][2]
As for the blood supply, it is thought that the majority of the labrum is avascular with only the
outer third being supplied by the obturator, superior gluteal, and inferior gluteal arteries. There is
controversy as to whether there is a potential for healing with the limited blood supply. The superior and inferior portions are believed to be innervated and contain free nerve endings and nerve sensory end organs (giving the senses of pain, pressure, and deep sensation). [1][2]
The labrum functions as a shock absorber, joint lubricator, and pressure distributor. It resists
lateral and vertical motion within the acetabulum along with aiding in stability by deepening the joint by 21%. The labrum also increases the surface area of the joint by 28%. This allows for a wider area of force distribution and is accomplished by creating a sealing mechanism to keep the synovial fluid within the articular cartilage. [1]
Labral tears can be classified by their location (anterior, posterior, or superior/lateral),
morphology (radial flap, radial fibrillated, longitudinal peripheral, and unstable), or etiology.[1] It is generally accepted that most labral tears occur in the anterior, anterior-superior, and superior regions of this acetabulum.
Etiology[edit | edit source]
With the advent of arthroscopic surgery as an accurate means of diagnosis (MRA), hip labral injuries have become of growing interest to the medical profession. Direct trauma, including motor vehicle accidents and slipping or falling with or without hip dislocation, are known causes of acetabular labral tears. [2] Additionally, childhood problems such as Legg-Calve-Perthes disease, congenital hip dysplasia, and slipped femoral capital epiphysis have been correlated to labral tears (Schmerl et al). While most tears occur in the anteriosuperior quadrant, a higher than normal incidence of posterosuperior tears appear in the Asian population due to a higher tendency toward hyperflexion or squatting motions.
Epidemiology[edit | edit source]
According to a systematic review by Leiboid et al, hip labral tears can occur between 8 to 72 years of age and on average during the fourth decade of life. 22-55% of patients that present with symptoms of hip or groin pain are found to have an acetabulular labral tear [1]. Up to 74.1% of hip labral tears cannot be attributed to a specific event or cause [1]. In patients who identified a specific mechanism of injury, hyperabduction, twisting, falling, or direct blow from a MVA were common mechanisms of injury [3]. Women, runners, professional athletes, participants in sports that require frequent external rotation and/or hyperextension, and those attending the gym 3 times a week all have an increased risk of developing a hip labral tear [3].
Differential Diagnosis[edit | edit source]
Given the etiology of this condition it is very important to obtain a good history, paying close attention to childhood problems such as Legg-Calve-Perthes disease, congenital hip dysplasia, slipped femoral capital epiphysis and trauma.
Schmerl and colleagues provide a thorough list for differential diagnosis of labral injury causing hip pain:
- Contusion (especially over bony prominences)
- Strains Athletic pubalgia
- Osteitis pubis
- Inflammatory arthridites
- Piriformis syndrome
- Snapping hip syndrome Bursitis (trochanteric, ischiogluteal, iliopsoas)
- Osteoarthritis of femoral head
- Avascular necrosis of femoral head
- Septic arthritis
- Fracture or dislocation
- Tumors
- Benign (simple bone cyst, osteoid osteoma, osteochondroma, fibrous dysplasia)
- Malignant (Ewing’s sarcoma, osteogenic sarcoma)
- Hernia (inguinal or femoral)
- Slipped femoral capital epiphysis
- Legg-Calve-Perthes disease
- Referred pain from lumbosacral structures and the sacroiliac joint
Magnetic resonance arthrography (MRA) is the diagnostic of choice for hip labral tears. Magnetic resonance imaging (without arthrography) and computed tomography (CT) have been shown to be unreliable diagnostic tests. [1]
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Pain: VAS
Muscle strength: measured by MMT and dynamometer
Disability: Lequesne Hip Score
Characteristics/Clinical Presentation[edit | edit source]
Due to difficulties in identifying specific mechanisms of injury for hip labral tears, generalizing typical signs and symptoms proves to be a rather challenging task. Ninety percent of patients with a hip labral tear have complaints of anterior hip and/or groin pain. [1][2] Less common areas of pain include anterior thigh pain, lateral thigh pain, buttock pain, and radiating knee pain. [3][1] Pain patterns and additional symptoms reported in studies include insidious onset of pain, pain that worsens with activity, night pain, clicking, catching, or locking of the hip during movement [2][1]. Functional limitations may include prolonged sitting, walking, climbing stairs, running, and twisting/pivoting [2][3][1].
According to a 2008 study by Martin et al, symptoms of groin pain, catching, pinching pain with sitting, FABERs test, flexion-internal rotation, adduction impingement test, and trochanteric tenderness were found to have low sensitivities (.6-.78) and low specificities (.10-.56) in identifying patients with intra-articular pain.
Examination[edit | edit source]
add text here related to physical examination and assessment
Medical Management
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Physical Therapy Management
[edit | edit source]
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Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed) [edit | edit source]
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<div class="researchbox"><rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1XsgQGan4PZgSWV7lHuqOwoB3kVayOlxxIU5pMP5CwL_1jZck7%7Ccharset=UTF-8%7Cshort%7Cmax=10</rss></div>
References[edit | edit source]
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- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskeletal Med. 2009; 2:105 - 117.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Lewis C, Sahrmann S. Acetabular labral tears. Physical Therapy. 2006;86(1):110-121.
- ↑ 3.0 3.1 3.2 3.3 Leiboid M, Huijbregts P, Jensen R. Concurrent Criterion-Related Validity of Physical Examination Tests for Hip Labral Lesions: A Systematic Review. The Journal of Manual & Manipulative Therapy. [online]. 2008;16(2):E24-41.
